ADHERENCE TO LONG-TERM TREATMENT OF CARDIOVASCULAR DISEASE AND NON-COMPLIANCE WITH MEDICAL RECOMMENDATIONS: THE OPINION OF PATIENTS AND PHYSICIANS BY THE RESULTS OF FOCUSED INTERVIEW

Aim. To study the subjective opinion of patients and doctors about their individual experiences with adherence to treatment for chronic cardiovascular diseases in the group focused interview of patients and their physicians.

Material and methods. 3 groups of patients from clinical studies adhering to the doctor's recommendations (focus-group 1) and 3 groups of patients hospitalized for cardiovascular events, not adhering to recommendations after discharge (focus-group 2) and one focus-group of doctors were analyzed. Group discussion was performed by a moderator (experienced sociologist, with no medical training who was not familiar with the patients and physicians).

Results. 47 patients (25 (53.2 %) men and 22 (46.8%) women) and 6 doctors participated in the study. Paternalistic model of communication with doctors present in the minds of all patients. In patients of the first group this results in a full confidence in the doctor and compliance with all recommendations while in patients of the second group lack of care in the outpatient clinic makes them "offended" by the underestimation of their trust and causes non-compliance. Physicians intuitively divide patients into less and more "attractive" for themselves. This "division" on the one hand may have some predictive value in respect of patients’ adherence to a further treatment, and on the other hand, the "doctors’ prejudice" in relation to the patient may adversely effect the behavior of the patients and failure to follow the recommendations in the future.

Conclusion. The significant paternalism on the part of the patient on the one hand increases the responsibility of the physician for his patient, and on the other hand – increases opportunities for his influence on the patients’ behavior.

1. World Health Organisation: Adherence to long-term therapies, evidence for action. Geneva:WHO; 2003.

2. Osterberg L, Blaschke T. Adherence to medication. NEMJ 2005; 353: 487-97.

3. Simpson SH, Eurich DT, Majumdar SR. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 2006; 333: 15.

4. Danilov DS. Compliance in medicine and its optimization methods (clinical, psychological and psychotherapeutic aspects). Psychiatry and Pharmacotherapy 2008; (1): 13-20. Russian (Данилов Д.С. Комплаенс в медицине и методы его оптимизации (клинические, психологические и психотерапевтические аспекты). Психиатрия и Психофармакотерапия 2008; (1): 13-20).

5. Fischer MA, Stedman MR, Lii J, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med 2010; 25 (4): 284-90.

6. Siluyanova IV, Yakovlev VV. Physician-patient relationship: the position of the patient. Dentist in 2011; (6): 4-8. Russian (Силуянова И.В., Яковлев В.В. Взаимоотношение врача и пациента: позиция пациента. Стоматолог 2011; (6): 4-8).

7. Chesnikova A.I., Safronenko V.A., Khripun A.V. Assessment of the degree of progression of coronary atherosclerosis in patients with five-year history of myocardial infarction, depending on the commitment of statin therapy. Rational Pharmacother Card 2012; 8 (6) :772-776. Russian (Чесникова А.И., Сафроненко В.А., Хрипун А.В. Оценка степени прогрессирования атеросклероза коронарных артерий у пациентов с пятилетним анамнезом инфаркта миокарда в зависимости от приверженности терапии статинами. Рациональная Фармакотерапия в Кардиологии 2012;8(6):772-776

8. Strokova E.V., Naumova E.A., Schwartz Yu.G. Commitment to long-term treatment of cardiac patients with mild to moderate depression: the ineffectiveness of antidepressant therapy in a randomized trial pirlindol. Rational Pharmacother Card 2012, 8 (1) :45-50. Russian (Строкова Е.В., Наумова Е.А., Шварц Ю.Г. Приверженность длительному лечению кардиологических пациентов с легкой и умеренной депрессией: неэффективность антидепрессивной терапии пирлиндолом в рандомизированном исследовании. Рациональная Фармакотерапия в Кардиологии 2012;8(1):45-50)

9. Puchinyan N.F., Dovgalevsky J.P., Dolotovskaya P.V., Furman N.V. Adherence to recommended therapy in patients with acute coronary syndrome, and risk of cardiovascular events in the year after hospitalization. Rational Pharmacother Card 2011; 7 (5) :567-573. Russian (Пучиньян Н.Ф., Довгалевский Я.П., Долотовская П.В., Фурман Н.В. Приверженность рекомендованной терапии больных, перенесших острый коронарный синдром, и риск развития сердечно-сосудистых осложнений в течение года после госпитализации. Рациональная Фармакотерапия в Кардиологии 2011;7(5):567-73)

10. Merton R, Fiske M, Candall P. The focused interview. Glencoe, Illinois: The Free Press; 1956.

11. Belanovsky SA. The focus groups method. Moscow: Magistr; 1996. Russian (Белановский С.А. Метод фокус-групп. М.: Издательство Магистр; 1996).

12. Sidorov PI, Parnyakov AV. Clinical Psychology: a textbook for high schools. 3rd edition. Moscow: GEOTAR Media; 2008. Russian (Сидоров П.И., Парняков А.В. Клиническая психология: учебник для вузов. 3-е издание. М.: ГЭОТАР-Медиа; 2008).